A longitudinal study of men with male genital schistosomiasis (MGS) in Southern Malawi associated with human, zoonotic and hybrid schistosomes

In sub-Saharan Africa s endemic areas for urogenital schistosomiasis, Male Genital Schistosomiasis (MGS) can cause significant morbidity. As part of the Hybridization in UroGenital Schistosomiasis (HUGS) investigation, a MGS sub-study examined a cohort of adult men over a calendar year to better ascertain general infection dynamics and putative zoonotic schistosome transmission. During follow-up, demographic, health and socioeconomic data were collected through individual questionnaire interviews. Collected urine and semen were analysed using urine filtration, urine and semen microscopy and molecular DNA analyses of semen. Ten participants with reported MGS-associated symptoms had Schistosoma eggs in their urine and semen at 6 months follow up, with seven at 12 months. Ten out of eleven participants with S. haematobium eggs on semen microscopy at baselinehad persistent infection at 6 months follow-up, together with 6 new participants, giving an MGS prevalence of 84.2% (n=19). Two also had S. mattheei eggs co-infection. Four of the 13 participants at 12 months follow-up had S. haematobium eggs in their semen which were persistent at all the time-points. Using semen PCR, 14 participants (73.7%) had Schistosoma infection at 6 months, with only 2 participants being infected for first time. Upon DNA analysis, three participants also had hybrid co-infection at this time-point. At 12 months, only six participants had Schistosoma infection with no hybrids detected. In summary, like S. haematobium and despite praziquantel treatment, both zoonotic and hybrid schistosomes can continue to cause MGS, which pose a further tangible challenge in future management and control measures.